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Health care changes to be discussed at Faculty Senate meeting

September 3, 2013

Health care changes to be discussed at Faculty Senate meeting

At its first meeting of the semester, the Faculty Senate will address the changes in Penn State's health care plan. Earlier this month, the Senate posed a series of questions to Susan Basso, vice president for Human Resources, and David Gray, senior vice president for Finance and Business. Basso and Gray have provided responses to those questions, and also will address them at the Senate meeting on Sept. 10.

In advance of the meeting, the Senate has posted the questions and answers, as Appendix C in the agenda for the Sept. 10 meeting, to its website at http://senate.psu.edu/agenda/2013-2014/sep2013/fullagenda.pdf online. Those questions and answers also appear below. Employees are encouraged to continue to seek answers to their questions about benefits by contacting their unit's human resources representative, or contacting Penn State's Office of Human Resources at benefits@psu.edu or 814-865-1473. More information is expected to be mailed to employee homes in the coming weeks.

Taking Care of Your Health

QUESTION: Why is a punishment-based, coercive approach necessary? Why is an incentive-based, voluntary approach not used?

Penn State historically has approached wellness with a voluntary approach resulting in limited participation and marginal results. Since January 2008, approximately 1 percent of Penn State covered employees and family members each year completed the online Wellness Profile available to them on the Highmark Health Services Member Website. During that same time period, no more than 5 percent of Penn State employees participated in the voluntary Penn State Health Matters programs that were available to them.

There are numerous published studies that demonstrate the positive impact that financial differentials have on participation, behavior change, risk reduction and cost reduction for preventable healthcare claims. When financial factors are integrated with premium contribution level, participation/completion rates in wellness programs can be expected to increase to the 75 percent -90 percent range. (Chapman, American Journal of Health Promotion, September/October 2008)

Whether structured as an incentive or disincentive, the creation of a financial differential between those who participate in wellness versus those that do not, significantly increases participation. The University could have structured its program as an incentive by overinflating health care premiums for all employees and then discounting for those who participate. However, the University did not feel that was fiscally responsible. The current strategy keeps premiums stable for all with no hidden costs.

QUESTION: Many of us already get regular, preventive medical examinations. Why do we need to go through the biometric screening or fill out the questionnaire? Can’t our numbers be obtained from our physicians?

Based on historical data, many members fail to get the recommended preventive services appropriate to their age and gender. For example, Penn State University’s compliance rate for physical exams submitted by physicians was a mere 17.3 percent for 2012. Further, Penn State University showed a non-user rate (defined as individuals who incurred no medical or prescription drug claims at all) of just over 10 percent for its active members in 2012. Non-use of the plan does not signify a healthy person – it suggests the potential existence of health risk factors for an individual who is not engaged in their health. The biometric screening opportunity raises awareness and encourages members to learn their numbers first hand. Additionally, Penn State employees are counseled, on the spot, when they receive the results of their screenings. For many people, this becomes a teachable moment, or “tipping point” for their health practices. For example, a risk detected early can motivate an individual to see their physician for treatment, begin to exercise, or change their nutrition.

As an alternative to the biometric screenings, Penn State employees may ask their physician to perform the screenings or report results you obtained between January 1, 2013, and now. A Physician Derived Results (PDR) form and instructions for its use are included on the employee benefits website.

Likewise, the Wellness Profile is also designed to raise awareness by providing the member with an individualized report after its completion. This report is something that can be shared and discussed with a member’s physician (ideally during an annual physical exam) which can also lead to opportunities for behavior change. Capitalizing on these opportunities contribute to the effort of long term reduction in claim trend and improved member health.

The Survey, Security and Privacy, and Use of Data for Future Purposes

QUESTION: Why was the WebMD platform chosen for the survey?

Highmark Health Services contracted with WebMD Health Services to provide a Personal Health Record, Wellness Profile, and many other related resources designed for individuals to manage their health. It is important to note that WebMD Health Services is different from WebMD.com which operates a separate public website that allows free access to health and wellness information and generates revenue through the sale of advertising on its site. The services and resources offered by WebMD Health Services are purchased by health plans and employer groups, and WebMD Health Services does not allow any advertising on its websites. Like many other national health insurance plans, Highmark Health Services determined it was more efficient and cost effective to partner with WebMD Health Services than to build these resources internally. Therefore, Highmark Health Services entered into a business associate relationship with WebMD Health Services. The decision to partner with WebMD Health Services was made after a RFI (Request for Information) and RFP (Request for Proposal) process that evaluated available resources and tools, success in enabling individuals to modify lifestyle behaviors, and information security across a number of vendors.

QUESTION: WebMD has been hacked in the past. Why should we believe it would not be hacked again?

Highmark Health Services is contracted with WebMD Health Services which is only available for direct purchase by Health Plans and Employer groups. WebMD Health Services has no evidence that a third party has ever gained unauthorized access to its systems and obtained information about end users. WebMD.com, the consumer-facing publicly available site operated by WebMD LLC similarly has no such evidence about its site. For these reasons, it is not clear what the question refers to when stating that “WebMD has been hacked in the past.” While no system is “hack-proof” WebMD Health Services employs state of the art security procedures to protect the information of end users. WebMD Health Services’ security infrastructure complies with the HIPAA security rules and is audited by an independent third party on an annual basis. WebMD Health Services takes a multi-layered “Defense in Depth” approach to securing its web-based tools by implementing complementary security controls at the physical, network, system, and application layers. In addition to technical controls, WebMD Health Services’ overall security strategy encompasses security management practices designed to ensure that its applications are not only built securely, but maintained securely as they evolve over time. User access to all of its applications occurs via 128-bit SSL encryption, which ensures a high degree of confidentiality and data integrity between WebMD Health Services and its clients.

QUESTION: If our health care information is already saved in a secure medical database, then why must our information be stored in an additional database?

There are two platforms that store our members’ clinical data. The WebMD Health Services platform includes the wellness profile, personal health record, and other resources like the tool for tracking which participants satisfied the “Taking Care of Your Health” requirements. The Highmark Health Services’ platform utilizes information from the wellness profile as well as claim data to identify members who might benefit from case management, disease management or wellness coaching. Additionally, Highmark Health Services nurses responsible for care and case management benefit by having a more complete member profile, which in turn helps them to provide a more tailored approach when working with individuals. Information must be exchanged between the Highmark Health Services and WebMD Health Services databases in order for each of the platforms to provide the required functionality. This paired functionality is what leads to more effective case management and health coaching outcomes, which is another element critical to the effort of claim trend reduction and improved member health.

QUESTION: Will WebMD and/or Highmark Health Services share any portion of our information to third parties for marketing or other purposes?

No member information will be disclosed to third parties for marketing purposes. The reference to Third Parties in the WebMD Health Services privacy policy refers to the possibility that WebMD could disclose information to subcontractors whose services may be needed to deliver health promotion and wellness services to clients and members. The contract between Highmark Health Services and WebMD Health Services requires that Highmark Health Services approve the use of subcontractors prior to their engagement and that WebMD Health Services and all of their approved subcontractors with access to member information must meet security standards and comply with the terms of our business associate agreement. This business associate agreement governs how member information can be used and specifically prohibits member information from being used or disclosed in any way other than as permitted in our contract. In addition, the HITECH Act and recent amendments to the HIPAA Rules make certain HIPAA Privacy and Security requirements directly applicable to Business Associates, including their subcontractors.

QUESTION: To whom and in what form will WebMD and/or Highmark report results?

WebMD Health Services will report program participation and wellness profile data only to Highmark Health Services. Highmark Health Services will provide a list of those who completed the requirements of the “Take Care of Your Health” Program to Penn State in order that the the financial differential can be administered. Highmark Health Services will also provide aggregate data to Penn State in order to help in the development of health promotion strategies or for other health plan operation purposes. Highmark Health Services will not report individual results to Penn State.

Member information received by Highmark Health Services related to biometric screenings and wellness profile results are used for health plan operations. Highmark Health Services uses this information for case management, care management and engagement with Health Coaches. Reporting provided by Highmark Health Services to our clients generally includes aggregate reports to help the client develop more targeted health promotion strategies as well as a list of individuals who completed the requirements of a program like “Take Care of Your Health”. WebMD Health Services provides reporting only to Highmark Health Services.

QUESTION: How will these data be used?

Member information received by Highmark Health Services and WebMD Health Services will be used for health plan operations purposes. This includes developing strategies for health promotion and wellness and for identifying members with acute, chronic and / or potentially life-threatening conditions in order that these individuals can be offered disease management services. In addition, the data are used to identify those who may benefit from wellness coaching provided by a Highmark Health Services RN Health Coach or Wellness Coach and to reach out to these individuals to offer these services.

QUESTION: Will the collected data be used to charge premiums based on health conditions now or in the future?

Penn State will never have access to an individual’s health records, will never ask for those records and will not charge an employee additional fees based on individual health status now or in the future.

Value of the Program to Health Outcomes

QUESTION: What are the health care claims costs, the premiums paid by the employee and Penn State, and the administrative costs for the last five years, compared to those projected for next year?

QUESTION: Are there studies showing that programs similar to the “Take Care of Your Health” program have produced positive health outcomes and reduced health care costs?

Positive ROI (Return on Investment) and trends in health care utilization and expenses have been well-documented in rigorous studies which are published in peer-reviewed journals. Examples are below:

A systematic literature review conducted by The Community Guide to Preventive Services, housed at the Centers for Disease Control and Prevention (CDC) and led by Dr. Robin Soler, evaluated carefully screened studies of health promotion programs and policies introduced by employers over the course of the past thirty years. Applying Community Guide systematic review methods, Soler et al. examined behavioral, biometric, and business-relevant outcomes reported in 51 studies that met inclusion criteria established by the Task Force.

The overall conclusion of the review was that comprehensive, well-conceptualized, and theory-based worksite programs do exert a positive influence on certain health behaviors, biometric measures, and financial outcomes important to employers. The Task Force found strong or sufficient evidence that comprehensive programs can reduce rates of tobacco use, dietary fat consumption, seat belt non-use, high blood pressure, total serum cholesterol levels, high-risk drinking, and the number of days absent from work because of illness or disability among participating employees. They also found improvements in workers’ physical activity, overall health and well-being scores, and health care use, especially in terms of reduced hospital admissions and days of care.

The Community Guide Task Force performed an economic analysis to determine whether these programs save money and whether they deliver a positive ROI. The results were promising, underscoring the potential for evidence-based programs to achieve a financial payback to employers implementing worksite programs. Estimates by researchers and economists at Harvard cite a $3.00 return for every dollar invested, over a three-year time horizon, from effective worksite health promotion programs.

A study was published in 2008 in the Journal of Occupational and Environmental Medicine which demonstrated savings of $1.65 in health care expenses for every $1 spent on Highmark Health Services’ comprehensive employee wellness program that includes:-- Health risk assessments-- Onsite fitness center facilities-- Health coaching-- Online and onsite wellness interventions

The study showed Highmark Health Services saved $1.3 million from 2002 to 2005 and demonstrated that total health care expenditures grew more slowly for wellness program participants than for nonparticipants, particularly in regard to inpatient expenditures.

Highmark completed a four-year evaluation in 2009 of 11,438 matched participants from 51 employer groups with established worksite wellness programs to determine the impact on the employee population and health. Results from this study demonstrated that employers who participate in wellness programs for two and four years respectively have statistically significant lower medical expenses relative to no wellness program participation. Wellness program participants demonstrated significantly lower increases in overall medical, inpatient and professional expenses and incurred a greater increase in clinical preventive service expense than the matched control group participants:-- 18.7 percent higher preventive care services-- 17.3 percent lower medical expenses-- 23.4 percent lower inpatient expenses-- 30 percent lower professional services utilization

A study published in the March/April 2011 edition of the American Journal of Health Promotion found health care costs rose at a 15 percent slower rate among wellness participants than a comparison group when employers consistently offered a wellness program to their members. The four-year study of select Highmark Health Services employer group wellness programs showed savings per participant as $332 annually, indicating substantial savings may result for group customers once a worksite wellness program is established.

The study evaluated the impact of worksite wellness programs on health care costs and utilization over time by matching approximately 10,000 wellness program participants at 47 Highmark employer groups with a risk-matched, gender-matched, and age-matched comparison group. At a minimum, the employer groups offered Web-based wellness programs from Highmark Health Services to their employees consistently for three or more years.The study also found that wellness program participants developed a greater tendency to pursue preventive services such as preventive physicals, mammograms and cancer screenings, than their comparison group counterparts, possibly as a result of self-care knowledge obtained from their worksite wellness programs. Preventive care measures often cost employers more in the short term, but can help to save longer-term health care costs.

QUESTION: How will you determine that compliance with the new policy has improved health outcomes and reduced health care costs at Penn State?

As Penn State remains committed to its Take Care of Your Health strategy for the long-term, participation, risk reduction, and preventable claims costs will be assessed using population health management evaluation tools. Highmark Health Services will measure and quantify results including behavior change, risk reduction, and impact on trend. However, the success of a worksite wellness program alone is not enough to effectively control the escalating rate of healthcare costs. Organizations who experience the most success often employ a multi-faceted approach that encourages an optimum balance of transparency, consumerism and engagement through the use of effective health plan design, cost-share and incentives. Like most employers its size, Penn State University self-funds its health insurance plan and uses Highmark as the administrator of its plan. Because the medical and prescription drug claims comprise more than 95 percent of the total health plan cost, embracing innovative strategies such as those being implemented are critical to the long term financial viability of the plan. In short – Penn State University controls its own destiny through the willingness to embrace such strategies.